While conflicting data as to the effect of hard surfaces call into question the assumption that surface density is directly related to metatarsal problems (Laker, Saint-Phard, Tyburski, et al., 2007), the insufficient cushioning properties of athletic footwear likely increases the overall risk nevertheless.
Proper fitting, particularly in the lateral dimension (i.e. width) is directly related to increased susceptibility to metatarsal problems because it further (artificially) contracts the overall surface areas available to dissipate and absorb dynamic forces by squeezing the metatarsals closer to each other as well (Cullen & Hadded, 2004). Finally, excessive roominess in athletic footwear can also contribute to stress fractures and other debilitating foot problems by allowing the foot to develop momentum within the shoe and resulting in momentarily high loads when the foot rapidly decelerates against the walls of the shoe
(Logan, 2009).
Injury Treatment in the Acute Phase:
R.I.C.E
As always, the primary treatment for athletic injuries involving inflammation or trauma begins with rest, ice, compression, and elevation (RICE), all designed to minimize the accumulation of blood and synovial fluid that retards healing by inhibiting the supply of oxygenated blood to the injured tissue and by requiring the its gradual breakdown and re-absorption. Metatarsal stress fractures are associated with significant bone marrow edema (Frankel & DiFiori, 2007) and therefore benefit tremendously from rest and icing in particular.
Crutches/walking boot
As in all injuries involving stress fractures to bone, rest and the elimination of weight bearing is crucial (Howe, 2007). Metatarsal fractures heal well provided the athlete suspends participation in any activity that subjects the metatarsals to continued stress of the kind that precipitated the trauma in the first place. Crutches and walking boots are generally sufficient and the patient may continue to ambulate during the healing process. Generally, pain is an appropriately accurate indication in this regard and should be heeded as evidence that the region has been exposed to continual stress capable of delaying or interfering with proper healing (Iazetti & Rigutti, 2007).
Rehabilitation stages:
Short-Term Goals
During the first phase of rehabilitation, the immediate goals include reduction of the stresses responsible for the development of stress fractures, minimization and reduction of swelling, and pain control. For that purpose, crutches in conjunction with a walking boot are often used for the first week. Usually, the athlete may continue self ambulating provided it does not cause pain. As with athletic injuries in general, continued (or recurring) pain is treated as an indication that the previous phase of rehabilitation has not been sufficient for recovery; therefore continued pain in subsequent phases necessitates a return to this phase of treatment. Generally, a walking boot is used for the first two to three weeks, followed by several weeks of light non-weight-bearing training. The absence of continued or recurring pain in this phase allows a gradual return to athletic activity although not at a strenuous level and only with deliberate limitation of any plyometric stresses (Frankel & Difiori, 2007).
Long-Term Goals
The second phase of rehabilitation consists of a gradual return to light plyometric loading at about six weeks, subject to any discomfort. Provided the patient experiences no discomfort or swelling, exercises are begun to restore neuromuscular control, range of motion, and muscular strength, all of which deteriorate very quickly during any period of immobilization such as associated with the walking cast (Vu, McDiarmid, Brown, et al.,
2006). One of the most productive rehabilitation exercises in this phase consists of reverse (i.e. backwards) stair climbing, because the motion of raising the front of the foot targets the muscles on the front of the shins and also increases flexibility of the ankle joint lost during immobilization in the walking boot (Frankel & Difiori, 2007).
Criteria for Full Return to Athletic Competition
The final phase of rehabilitation transitions to the evaluation phase in which the athlete is evaluated for stability and balance while simultaneously building up cardiovascular and respiratory conditioning to pre-injury levels. At this stage, resumption of training is limited only by recurrence of symptoms, which...
). Non-Pharmacological Management of Plantar Fasciitis The ideal management of plantar fasciitis is prevention, which is through appropriate warm-up exercises, quality shoes and exercises at an appropriate training level on a safe surface (Miller 2004). Barrett and O'Malley (1999) recommend a conservative treatment that addresses the inflammatory element causing the discomfort and the biomechanical factors producing the disorder. To complement the treatment, the patient should be adequately educated on the etiology of their
Osteomyelitis in the Diabetic Patient Management OF OSTEOMYELITIS IN THE DIABETIC PATIENT Osteomyelitis is an infection of the bone or bone marrow which is typically categorized as acute, subacute or chronic.1 It is characteristically defined according to the basis of the causative organism (pyogenic bacteria or mycobacteria) and the route, duration and physical location of the infection site.2 Infection modes usually take one of three forms: direct bone contamination from an open
Our semester plans gives you unlimited, unrestricted access to our entire library of resources —writing tools, guides, example essays, tutorials, class notes, and more.
Get Started Now